A Guide to Caregiving in Senior Care

What Is a Caregiver?

Caregivers are people who help someone with personal care, medical tasks, and/or activities of daily living (ADLs). The person being assisted usually needs short-term or long-term care because of an injury, illness, or disability.1 Seniors typically receive care in their home, but a caregiver can also come into a long-term care facility to deliver care.

Unpaid loved ones, paid loved ones, home health aides, companions, or other paid professionals serve as caregivers. Sometimes the caregiver is a person from your church or a trusted neighbor. It’s very possible that you or someone you know is already a caregiver. Let’s find out!

You may be a caregiver if you’ve helped someone in need with:

• Dressing, bathing, and/or grooming
• Transportation to the grocery store and medical appointments
• Housework and yard work
• Meal prep
• Budgeting, taxes, and managing money

How to Decide if You Need a Caregiver

Your aging loved one likely already has multiple caregivers in their life, but you might be wondering if it’s time to create a formal arrangement with a regular caregiver.

Signs Your Loved One Needs a Regular Caregiver

If your loved one is showing signs that they need a regular caregiver, but they’re resistant to the idea, don’t worry. Change is hard, especially as we get older. View our guide on how to talk to your loved one about caregivers for tips about starting the conversation.

What Are a Caregiver’s Duties?

Caregivers do as much or as little as the situation requires. Some common duties, which can change over time, include:

• Home maintenance: housekeeping, yard work, and simple repair jobs
• Care planning: creating a care plan for their loved one with help from the whole care/medical team
• Medical advocacy: ensuring their loved one is receiving proper care and being treated fairly
• Prescription medication management
• Help with activities of daily living
• Meal prep and nutrition
• Transportation
• Companionship
• Money management: paying bills, preparing taxes, budgeting, and monitoring bank accounts

What Qualities Should You Look For in a Caregiver?

A caregiver will spend a lot of time with the senior receiving care. That’s why it’s so important to find someone whose personality meshes with your loved one. Is your loved one outgoing and talkative? Choose a caregiver that enjoys chatting. Are they more reserved? Choose a caregiver who’s on the quieter side.

Other factors you should consider when hiring or choosing a caregiver include:

• Experience: Look for someone who has experience caregiving for those with similar needs to your loved one.
• Training: Training can be an indicator of a quality caregiver. Certified home health aides undergo formal training to learn how to assist with activities of daily living. Other training to look for includes CPR and basic first aid.
• Trustworthiness and Reliability: Caregivers take on a lot of responsibility, so you want someone you can trust. You’ll need someone who will take proper care of your loved one, show up on time, respect the home they’re in, admit if they make a mistake, and only log hours worked. Before hiring, check references and run a formal background check.
• Vaccinations: For the safety of the senior and the caregiver, you might insist on hiring a person who is immunized against influenza, shingles, pneumonia, tuberculosis, and/or other transferable diseases. You can learn about vaccination laws for healthcare workers in your state through the Centers for Disease Control.
• Choose a Bonded and Insured Caregiver: Licensed home care agencies that are bonded and insured pay for protection in case employees are responsible for damage, theft, or other financial losses to their clients.

Can Medicare Pay for a Caregiver?

Medicare will sometimes pay for a caregiver, but not always. Your loved one will only qualify if they have Medicare Part A and B, are under the care of a doctor, need a covered service, and are homebound with a doctor’s certification.2

Covered services include:

• Physical therapy, occupational therapy, and speech-language pathology services
• Part-time skilled nursing care
• Medical social services
• Part-time home health aide services
• Osteoporosis drug injections for women

Seniors who need at least one of the covered services can also use Medicare to pay for homemaker services like shopping or laundry and personal care services like dressing or bathing.

How Much Does Medicare Cover?

Original Medicare covers 100 percent of home health care services for qualifying individuals. That means you’ll owe $0 for covered services! Just make sure you ask the home health agency what’s covered and what’s not. You might have to pay out of pocket for services that aren’t covered by Medicare, such as meal delivery or 24-hour-a-day at-home care.

If your loved one isn’t eligible for Medicare coverage, they aren’t out of luck! We’ve found that many families use private pay, private medical insurance, long-term health insurance, Medicaid, or Veteran’s Benefits to afford a caregiver.

Types of Caregivers

Family or Unpaid Caregivers

In 2015, nearly 34.2 million Americans cared for adults ages 50 or over,3 and they did it without any pay. These individuals are called family caregivers or informal caregivers. Informal caregivers don’t need to be related to the senior receiving care. It could be a significant other, a close friend, or a trusted neighbor.

You could be a family caregiver without realizing it because, simply put, caregiving is helping someone do regular life activities. Family caregivers may perform any of the typical caregiving services, including meal prep, transportation, housekeeping, and assistance with ADLs. Informal caregivers are best for:

• Seniors with dedicated loved ones who have flexible schedules
• Older adults who want to age in place
• Seniors who do not need major medical assistance

Formal Caregivers

Formal caregivers, also called homemakers, home health aides, personal care attendants, or companions, are professional caregivers who receive compensation for their services. A formal caregiver may work in a private home, adult day care facility, or a long-term care facility. Formal caregivers provide many of the same services as informal caregivers. They may also help with basic medical tasks. We’d recommend formal caregivers for:

• Seniors whose loved ones cannot meet their needs
• Older adults who want to safely age in place
• Those who do not need major medical assistance
• Seniors who don’t feel comfortable having a family member assist with personal hygiene tasks
• Seniors whose loved ones need a temporary break from caregiving

How to Get Paid to Be a Caregiver for Parents

Adult children who care for their parents may be eligible for compensation. We found a few different options worth exploring further if you’d like to be paid for taking care of your parent(s).4

Medicaid

Each state offers self-directed long-term care services through Medicaid, but the exact benefits and eligibility criteria vary. The name for this type of care also varies, depending on where you’re from. Some states, like Virginia or Texas, use “Consumer Directed Care” while others opt for “In-Home Support Services” or “Cash and Counseling.”

If your parent qualifies for this self-directed care, the next step is creating a service plan that explains the type of help needed. Once that’s all set, your parent or a surrogate chooses a caregiver. If the state permits it, a senior can choose one of their children as their caregiver. Medicaid would then pay the caregiver. Contact the Medicaid program in your state to learn about their self-directed care program.

Programs for Veterans

Is your mom or dad a veteran? If so, look into the four different options available to vets and their spouses below.

State Paid Family Leave Laws

Paid family leave is an option for some workers in several states. This benefit is also called wage replacement because it lets workers receive a portion of their usual workplace wages while caring for family. Each locale has different policies regarding who is eligible, for how long, and what percentage of their wages can be replaced. The following regions have laws in place:

1. California
2. New Jersey
3. New York
4. Rhode Island
5. Washington, D.C.

Caregiver vs. Nurse: What’s the Difference?

Some seniors need a higher level of care than a caregiver can provide. That’s where private duty registered nurses come in. Nurses and caregivers differ in three main ways. Understanding the differences is key so that you hire the correct help.

1. Duties

Registered nurses provide medical care to their clients. This could mean monitoring vital signs, changing wounds, inserting and maintaining catheters, administering medications, or providing end-of-life care. Caregivers provide non-medical care like housekeeping, companionship, and help with ADLs.

2. Education and Training

Nurses need at least an associate degree in nursing and must also pass a certification exam to become a registered nurse. While earning their degree, nurses complete clinical hours, which involves working directly with patients and learning from practicing nurses.

Caregivers, like family members, personal care assistants (PCAs), or home health aides (HHAs) do not need formal training. The only exception being for PCAs or HHAs who receive Medicaid or Medicare funds. Some states require additional training, but it’s not as comprehensive as a nurse’s training.

3. Cost

Hiring a registered nurse for in-home care costs a lot more than hiring a non-medical caregiver. A non-medical caregiver like an HHA costs an average of $ 16.05 per hour, while a registered nurse working in-home health care services makes $42.04 per hour on average.5

A caregiver is often enough for seniors who just need help with personal care, managing medications, and other ADLs. Registered nurses are great for seniors who:

• Have diabetes
• Have severe physical disabilities
• Have heart problems
• Recently suffered a stroke
• Recently had surgery
• Need ongoing skilled nursing care to manage an injury or illness